Hospital academic status is associated with failure-to-rescue after colorectal cancer surgery

Miriam Lillo-Felipe,Rebecka Ahl Hulme,Gabriel Sjolin,Yang Cao,Gary A Bass,Peter Matthiessen,Shahin Mohseni

doi:10.1016/j.surg.2021.01.050

Abstract

BackgroundFailure-to-rescue is a quality indicator measuring the response to postoperative complications. The current study aims to compare failure-to-rescue in patients suffering severe complications after surgery for colorectal cancer between hospitals based on their university status. MethodsPatients undergoing colorectal cancer surgery from January 2015 to January 2020 in Sweden were included through the Swedish Colorectal Cancer Registry in the current study. Severe postoperative complications were defined as Clavien-Dindo ≥3. Failure-to-rescue incidence rate ratios were calculated comparing university versus nonuniversity hospitals. ResultsA total of 23,351 patients were included in this study, of whom 2,964 suffered severe postoperative complication(s). University hospitals had lower failure-to-rescue rates with an incidence rate ratios of 0.62 (0.46–0.84, P = .002) compared with nonuniversity hospitals. There were significantly lower failure-to-rescue rates in almost all types of severe postoperative complications at university than nonuniversity hospitals. ConclusionUniversity hospitals have a lower risk for failure-to-rescue compared with nonuniversity hospitals. The exact mechanisms behind this finding are unknown and warrant further investigation to identify possible improvements that can be applied to all hospitals.

Highlights

Measuring quality of care has become a variable of increasing importance over the years
There were no differences in sex, total hospital length of stay (LOS), or unplanned reoperations between the university and nonuniversity hospitals
There was no statistical significance in FTR rates for neurological complications (28.6% vs 68.4%; P 1⁄4 .095) (Table IV, Fig 1). This large, retrospectively analyzed cohort of patients undergoing colorectal cancer surgery in Sweden suggests a significant risk increase in FTR at nonuniversity hospitals compared with university hospitals

Summary

Introduction

Measuring quality of care has become a variable of increasing importance over the years. M. Lillo-Felipe et al / Surgery 170 (2021) 863e869 short-term postoperative outcomes in colorectal surgery.[8,9] Proposed reasons for better results from high-volume centers include providing experienced surgeons with a high number of operative cases, well-structured and well-defined health care pathways, better surgical techniques, and appropriate patient selection.7,10e12 A more debated variable is a hospital’s academic status or teaching status and whether this influences clinical outcomes. The current study aims to compare failure-to-rescue in patients suffering severe complications after surgery for colorectal cancer between hospitals based on their university status. Failure-to-rescue incidence rate ratios were calculated comparing university versus nonuniversity hospitals. There were significantly lower failure-to-rescue rates in almost all types of severe postoperative complications at university than nonuniversity hospitals. The exact mechanisms behind this finding are unknown and warrant further investigation to identify possible improvements that can be applied to all hospitals

Methods

Results

Conclusion